Yreka, CA · Siskiyou County
Application for Low Income Discounts
Yreka residents use this application to request water and sewer base rate discounts and provide household income information.
What this form is
This application is for City of Yreka residents seeking water and sewer base rate discounts. The form shown is for the 2023 program year and says a new application must be filed with the Utility Department each calendar year; renewal applications are accepted between December 31 and February 20. It asks for applicant and service address details, household income information, signatures, and copies of recent income tax returns.
Who needs it
Yreka residents applying for the water or sewer base rate discounts must complete the application and provide proof of household income.
How to submit it
File the application with the Utility Department of the City of Yreka at 701 Fourth Street, Yreka, CA 96097. The form says a new application is required for each calendar year and asks applicants to include recent income tax returns.
About notarization
This application is signed without a notary; it includes a declaration under penalty of perjury and requires recent income tax returns as proof of income.
How to submit this form
- 1
Download The Application
Download the City of Yreka Low Income Discount Application.
- 2
Complete The Form
Print and complete the applicant, service address, contact, and household income information, then sign and date the application.
- 3
Gather Income Proof
Include a copy of the most recent income tax returns as proof of income for household members.
- 4
Submit To The Utility Department
File the application with the City of Yreka Utility Department at 701 Fourth Street, Yreka, CA 96097.
Frequently asked questions
- Do I need a notary for the Low Income Discount Application?
- No. The application is signed without a notary, but it includes a declaration under penalty of perjury and requires recent income tax returns as proof of household income.
- How do I submit the Low Income Discount Application?
- File the application with the City of Yreka Utility Department at 701 Fourth Street, Yreka, CA 96097. Include copies of the most recent income tax returns as proof of income.
- What discounts does the application request?
- The form lists a $2.00 monthly discount on the water base rate and a $2.00 monthly discount on the sewer base rate.
- What income proof does the application require?
- The application says proof of income is required for each resident and asks for a copy of the household’s most recent income tax returns, showing all household members’ income.
Need something notarized?
This Application for Low Income Discounts doesn’t need a notary — but if you have another Yreka form that does, a commissioned online notary can help.